Received from the Division of General Internal Medicine (MCB, DEF), Department of Medicine, The Johns Hopkins School of Medicine; Department of Health Policy and Management (MCB, DR, SL, DEF), The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md; Department of Medicine (WL), St. Michael's Hospital, University of Toronto, Toronto, Canada; Regenstrief Institute (RF), Indiana University School of Medicine; and Roudebush Veteran's Administration Medical Center (RF), Indianapolis, Ind.
What Do Physicians Tell Patients About Themselves?
A Qualitative Analysis of Physician Self-disclosure
Article first published online: 20 AUG 2004
Journal of General Internal Medicine
Volume 19, Issue 9, pages 911–916, September 2004
How to Cite
Beach, M. C., Roter, D., Larson, S., Levinson, W., Ford, D. E. and Frankel, R. (2004), What Do Physicians Tell Patients About Themselves?. Journal of General Internal Medicine, 19: 911–916. doi: 10.1111/j.1525-1497.2004.30604.x
- Issue published online: 20 AUG 2004
- Article first published online: 20 AUG 2004
- patient-physician communication;
- physician self-disclosure;
- patient-physician relationship;
- qualitative analysis
OBJECTIVE: Physician self-disclosure (PSD) has been alternatively described as a boundary violation or a means to foster trust and rapport with patients. We analyzed a series of physician self-disclosure statements to inform the current controversy.
DESIGN: Qualitative analysis of all PSD statements identified using the Roter Interaction Analysis System (RIAS) during 1,265 audiotaped office visits.
SETTING AND PARTICIPANTS: One hundred twenty-four physicians and 1,265 of their patients.
MAIN RESULTS: Some form of PSD occurred in 195/1,265 (15.4%) of routine office visits. In some visits, disclosure occurred more than once; thus, there were 242 PSD statements available for analysis. PSD statements fell into the following categories: reassurance (n= 71), counseling (n= 60), rapport building (n= 55), casual (n= 31), intimate (n= 14), and extended narratives (n= 11). Reassurance disclosures indicated the physician had the same experience as the patient (“I've used quite a bit of that medicine myself”). Counseling disclosures seemed intended to guide action (“I just got my flu shot”). Rapport-building disclosures were either humorous anecdotes or statements of empathy (“I know I'd be nervous, too”). Casual disclosures were short statements that had little obvious connection to the patient's condition (“I wish I could sleep sitting up”). Intimate disclosures refer to private revelations (“I cried a lot with my divorce, too”) and extended narratives were extremely long and had no relation to the patient's condition.
CONCLUSIONS: Physician self-disclosure encompasses complex and varied communication behaviors. Self-disclosing statements that are self-preoccupied or intimate are rare. When debating whether physicians ought to reveal their personal experiences to patients, it is important for researchers to be more specific about the types of statements physicians should or should not make.